Survey of British pathologists' performance of mesothelioma post-mortems

Our plain-English summary of Survey of British pathologists' performance of mesothelioma post-mortems, by R. Goldstein, P.S. Hasleton (Pathology, Research and Practice, 2010).

The study

• Authors: R. Goldstein, P.S. Hasleton
• Journal: Pathology, Research and Practice
• Published: 2010;206(3):174-9
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We analyzed the practice of mesothelioma post-mortems in the United Kingdom (UK). Between 2003 and 2004, a questionnaire was sent to all UK Consultant Histopathologists, and 12% were recruited. In general post-mortems, the Coroner approved 60% of requests for organ retention, and Pathologists failed to make such a request in 5.9% of cases. In asbestos cases, the lungs were not fixed for sampling in 54.8% of cases, owing to the Coroners' refusal in 46.4% and the pathologists' failure to make a request in 8.4% of cases. In epithelioid mesothelioma, mesothelial and epithelial stains were considered to be of similar importance, and calretinin was the most popular individual stain. In sarcomatoid mesothelioma, mesothelial stains were chosen by 45.9% of pathologists, cytokeratin by 18.7% and epithelial stains by 18.5%. Calretinin was the most popular stain. Accurate mesothelioma diagnosis is impeded by the lack of tissue being made available by the Coroner and failure of some pathologists to make requests. Pathologists use appropriate immunohistochemical testing in epithelioid mesothelioma. In sarcomatoid mesothelioma, epithelioid stains were popular but have limited use. The Coroner should approve more requests for organ retention, and information should be disseminated to pathologists regarding best practice in mesothelioma.

Copyright 2009 Elsevier GmbH. All rights reserved.

In plain English

This was a questionnaire survey of how pathologists in the United Kingdom carried out post-mortem examinations in mesothelioma cases. Between 2003 and 2004 the questionnaire went to all 1469 UK consultant histopathologists. Of the 222 who returned it, the 181 who performed adult post-mortems were included, among them 175 consultants, equal to 12% of UK consultant histopathologists. In non-asbestos cases, organs were not retained in 43.5%: coroners refused in 37.6% and pathologists did not ask in 5.9%. In asbestos cases, the lungs were not distended and fixed before sampling in 54.8%: coroners refused in 46.4% and 8.4% of pathologists did not ask. Coroners allowed lung tissue to be saved for an asbestos fiber count in 83.4% of cases, but only 22% of pathologists kept tissue for this. Almost two thirds took at least four tumor blocks, and 88% used immunohistochemistry along with other stains. The authors concluded that accurate diagnosis was impeded by coroners not making tissue available and by some pathologists not making requests. They noted that Scotland could not be compared with the rest of Britain.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Questionnaire survey of pathologists' post-mortem practice (cross-sectional survey)
• Who was studied: UK histopathologists. The questionnaire was sent to 1469 consultant histopathologists in 2003 to 2004. It was returned by 222, and 181 (81.5%) who perform adult post-mortems were included. These included 175 consultants, equal to 12% of UK-based consultant histopathologists. Of respondents, 83% worked in England and 3% in Scotland.
• Exposure: Not an exposure study. It compared post-mortem practice in asbestos-related cases (mesothelioma, asbestosis) with non-asbestos cases, including whether tissue was saved for an asbestos fiber count. No fiber types were studied.
• Main results:
  • Non-asbestos cases: organs were not retained in 43.5%, because of coroners' refusal in 37.6% and pathologists not making a request in 5.9%. This equated to coroners approving 60% of requests for organ retention.
  • Asbestos cases: the lungs were not routinely distended and fixed before sampling in 54.8%. In 8.4% pathologists did not ask, and in 46.4% coroners refused permission.
  • Coroners permitted lung tissue to be saved for an asbestos fiber count in 83.4% of cases, but only 22% of pathologists retained tissue for this purpose.
  • Almost two thirds of pathologists took at least four tumor blocks at post-mortem.
  • 88% of pathologists used a combination of H & E, mucin staining and immunohistochemistry. The remainder did not use special stains.
  • Epithelioid mesothelioma: mesothelial stains made up 47.8% and epithelial stains 42.3% of the stains chosen. Calretinin was the most important individual stain, followed by CEA, Ber EP4 and CK 5/6.
  • Sarcomatoid mesothelioma: mesothelial stains were selected most often (45.9%), compared with cytokeratin (18.7%) and epithelioid stains (18.5%). Calretinin was again the most popular individual stain.
  • 4.6% of pathologists referred epithelioid mesothelioma cases to specialist centers.
• The authors' conclusion: The authors concluded that accurate mesothelioma diagnosis is impeded by coroners not making tissue available and by some pathologists not making requests. They hoped coroners would approve more organ-retention requests and that best-practice information would be shared with pathologists.
• Limitations the authors state:
  • Practice in Scotland, which has a different coronial system, could not be compared with the rest of Britain, because only 3% of respondents were from Scotland.
  • The relative proportion of cases diagnosed during life versus only at post-mortem was not determined.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Epithelioid, Calretinin, Sarcomatoid.

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